Neuromodulation : journal of the International Neuromodulation Society
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Clinical Trial
Optimizing the duration of assessment of stage-1 sacral neuromodulation in nonobstructive chronic urinary retention.
The duration of test stimulation using two-stage sacral neuromodulation (SNM) is not studied. This study will determine the restoration of normal bladder sensation and resultant voiding in chronic urinary retention (CUR) after stage-1 SNM. ⋯ Stage-1 SNM may be left in situ for up to four weeks to ensure the maximum chance of restoring normal bladder function in this complex group of patients.
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Clinical Trial
Peripheral nerve field stimulation for chronic headache: 60 cases and long-term follow-up.
The objective of this study is to evaluate the efficacy of peripheral nerve field stimulation (PNFS) for the treatment of chronic headache conditions. ⋯ PNFS for chronic headache is an evolving therapy. This study demonstrates that this reversible and effective treatment can be a promising pain relief strategy for this often intractable condition.
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Sacral neuromodulation is Food and Drug Administration approved for many types of voiding dysfunction. Goals of treatment often include cessation of anticholinergic therapy. With the goal of understanding the impact of sacral neuromodulation on anticholinergic use, we analyzed patterns of care using a national claims-based dataset. ⋯ Sacral neuromodulation was associated with a significant decrease in the use of anticholinergic medication. Cost-effectiveness analyses that take into account patient quality-adjusted life years are needed to determine the true cost-benefit ratio of sacral neuromodulation.
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Spinal cord stimulators (SCS) function by transmission of electrical impulses to electrode contacts placed within the epidural space depending on the painful area to be treated. Because of the electrical nature of the SCS, there has been concern about the interaction between these devices and devices that monitor or augment the cardiac system. Implantable loop recorders help to identify the causes of syncope or palpitation by continuously evaluating and recording portions of an electrocardiograph in patients being evaluated for cardiac conduction arrhythmias. The purpose of the study is to simulate the possible effects of spinal cord stimulation on a Confirm cardiac monitor (St. Jude Medical, St. Paul, MN, USA). ⋯ Our study demonstrates that spinal cord stimulation is unlikely to interfere with the data collected by the Confirm loop recorder, and the presence of an SCS should not interfere with the ability to use a loop recorder for diagnostic purposes.
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Implanted peripheral nerve stimulation is one of the earliest developed methods of neuromodulation for the treatment of chronic neuropathic pain. It is traditionally performed by surgical exposure and implantation of a paddle lead. Ultrasound-guided percutaneous placement of cylindrical leads has been proposed as an alternative. However, those leads are fragile and prone to migration. Minimally invasive paddle lead implantation may improve long-term results while minimizing surgical insult. A feasibility laboratory study was performed. ⋯ This anatomic study confirmed technical feasibility of percutaneous placement of a narrow paddle-type lead for the peripheral nerve stimulation that may potentially improve stimulation and reduce migrations.